Most Americans Want Changes to Affordable Care Act

Story Highlights

More Americans disapprove than approve of Affordable Care Act

43% of Americans want law kept but with major changes

37% want law repealed and replaced

WASHINGTON, D.C. -- Americans' assessments of the Affordable Care Act (ACA) remain relatively unchanged after the Nov. 8 election, with more continuing to disapprove (53%) than approve (42%) of the law. Going forward, the vast majority of Americans want to see the law changed. This includes the 37% who want it repealed and replaced, along with a total of 43% of Americans who want the law kept, but with major changes.

In its annual November Healthcare update, conducted Nov. 9-13, Gallup asked Americans who approve of the ACA if they would like it kept in place as is, or kept but with significant changes. Similarly, Americans who disapprove of the ACA were asked if they wanted to keep it but with significant changes, or repeal and replace it.

Putting the responses to these two questions together, an overall total of 43% of Americans -- a group that includes some who approved of it initially (28%) and some who disapproved (15%) -- want to change the ACA significantly without repealing it. That is a slightly larger percentage than the 37% who disapprove and wish to see it repealed and replaced. Fourteen percent of Americans approve of the ACA and wish to keep it as is.

Disapproval of the ACA Has Been the Norm

Since Gallup began regularly tracking Americans' overall evaluations of the ACA four years ago, approval has exceeded disapproval only once, in November 2012, shortly after President Barack Obama's re-election. Since then, disapproval has averaged 52%, while approval has averaged 42%.

Attitudes toward the ACA continue to be highly partisan. The act's common name "Obamacare" highlights the degree to which it is attached to the Democratic president. The legislation, which was passed into law in 2010 despite "no" votes from all 178 Republican members of the House, became a point of contention between Donald Trump and Hillary Clinton during the election. Not surprisingly, rank-and-file Democrats have consistently been much more likely to approve of the ACA than Republicans. This month, 7% of Republicans say they approve of the ACA, compared with 76% of Democrats. This is fairly typical of the partisan spread in approval measured prior to the election.

Seventy-one percent of Republicans disapprove of the law and want to repeal it, essentially in line with Trump's campaign promise. Few Democrats want to see the ACA repealed and replaced. Instead, 59% of Democrats, including those who either approve or disapprove of the law in general, want to keep it with significant changes, mirroring Clinton's campaign platform position. Twenty-six percent of Democrats approve of the ACA and want to keep it as is.

Bottom Line

Shortly after his election earlier this month, Trump moderated his campaign promise to repeal the ACA, saying in an interview that he would attempt to keep two popular provisions: banning insurers from excluding people with pre-existing conditions and allowing young people to stay on their parents' insurance until the age of 26. It appears that, to avoid disruption, Republicans may attempt to vote to defund the ACA, but in a way that such an action would not be triggered until after the 2018 midterm elections, thus allowing Congress to attempt to change significant parts of it in the meantime.

Whatever the exact course of action that ensues once Trump and the new Congress take office, it is clear that about eight in 10 Americans favor changing the ACA significantly (43%) or replacing it altogether (37%).

Results for this Gallup poll are based on telephone interviews conducted Nov. 9-13, 2016, on the Gallup Poll Social Series, with a random sample of 1,019 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. For results based on the total sample of adults who approve of the Affordable Care Act, the margin of sampling error is ±6 percentage points at the 95% confidence level. For results based on the total sample of adults who disapprove of the Affordable Care Act, the margin of sampling error is ±5 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 60% cellphone respondents and 40% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

In the third quarter of 2016, the uninsured rate reached a low of 10.9% in Gallup's and Healthways' nine-year trend. This is down from 17.1% in the fourth quarter of 2013 before a key healthcare provision, the individual mandate, took effect.

Americans' support for the Affordable Care Act remains basically unchanged since May; 44% currently approve of the law. Nearly three in 10 Americans say the law has hurt their family, the highest Gallup has measured to date.